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Paediatrics > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

dDx vomiting infant

A 
Pyloric stenosis
GORD
Possetting
Gastroenteritis
Small bowel obstruction Systemic/localised infection
Hirshsprungs
Oesophageal fistula
Galactosaemia
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2
Q

dDx vomiting adolescent

A

Raised ICP
Migraine
Bulimia
Pregnancy (test all girls >12y)

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3
Q

Features pyloric stenosis

A

Characterised by gradual thickening of the pyloric muscles
More common in boys and first borns
Typically non-bilious vomiting at 2-8 weeks
Progressive frequency and forcefulness resulting in projectile vomiting following feeds
Loss of interest in feeds
Palpable pyloric mass in RUG with a full stomach
Visible gastric peristalsis from left to right
Hypochloremia, hypokalemic alkalosis, with increased bicarbonate

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4
Q

US pyloric stenosis

A

hypertrophy: thickness >4mm; length >18mm; failure fluid passage beyond pylorus

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5
Q

Mx Pyloric stenosis

A

Correct dehydration and electrolyte imbalances
Definitive treatment is myomectomy via RUQ or supraumbilical incision.
Normal feeding resumes after 6 hours

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6
Q

Features GORD

A

Typically following feeds, arching back, worse lying down after feeds, better sitting up
Address feeding techniques and positioning
Associated with cerebral palsy and neurodevelopmental disorder

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7
Q

Mx GORD

A

Thickening of feeds ,e,g, gaviscon
Acid suppression .e.g. Ranitidine, omeprazole
In severe cases surgery may be indicated- Nissens procedure high failure

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8
Q

Features possetting

A

Non-forceful regurgitation, milky vomit, low volumes

Parental reassurance

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9
Q

Features gastroenteritis

A

Inflammation of the bowel secondary to infection
Typically rotavirus in children: now on immunisation schedule
Sudden onset diarrhea and vomiting, typically affected contacts, weight loss, poor feeding

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10
Q

Cx gastroenteritis

A

Post gastritis syndrome: watery diarrhoea on reintroduction of normal diet, initiate oral rehydration

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11
Q

Mx gastroenteritis

A

Stool culture if immunocompromised, blood/mucus in stool or evidence of sepsis
Oral rehydration solution and isolation to limit spread

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12
Q

Features small bowel obstruction

A

May be recognised antenatally
Persistent bile stained vomiting and increasing prominent abdominal distention
Initial passage of meconium and no further stool

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13
Q

Features duodenal atresia

A

Commonly associated with down’s syndrome and congenital malformations
Double bubble on X Ray

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14
Q

Mx dudodenal atresia

A

NG decompression

Surgical correction

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15
Q

Features jejunum/ileum atresia

A

secondary to vascular occlusion in utero

may include multiple atretic segments

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16
Q

Features malrotation

A

Abnormal rotation during development
DJ flexure on right of midline
Volvulus formed when mesentery twists on own axis leading to vascular compromise and mechanical obstruction
Diagnosis by upper GI contrast

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17
Q

Mx malrotation

A

Ladd’s procedure to correct and removal of appendix to prevent later confusion with appendicitis

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18
Q

Features meconium ileus

A

Thickened impacted meconium in lower ileum

Commonly in cystic fibrosis

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19
Q

Mx meconium ileus

A

Enema and rectal washout

Laparotomy with temporary ileostomy

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20
Q

Features hirschsprungs

A

Absence of ganglion cells in mesenteric and submucosal plexus
Neonatal presentation as failure/delay in meconium passage
Abdominal distention, bile stained vomiting
Release of flatus and stool with PR examination

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21
Q

Mx hirschsprungs

A

Rectal biopsy shows absence of ganglion cells with large ACh positive nerve trunks
Definitive management: colostomy with anastomosis normally innervated bowel to the anus

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22
Q

Features oesophageal fistula

A

Persistent salivation, drooling, coughing and choking, especially when fed
Associated with VACTERL abnormalities
High risk of aspiration

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23
Q

Mx oesophageal fistula

A

NG tube passed and check on Xray to confirm structure

Surgery is definitive treatment

24
Q

dDx recurrent abdominal pain

A 
Abdominal migraine
Irritable bowel syndrome
Peptic ulceration
Gastritis
Esoinophilic oesophagitis
functional abdominal pain
25
Q

dDx acute abdominal pain

A 
Colic
Mesenteric adenitis
DKA
Acute appendicitis
HSP
UTI
Lower lober pneumonia
Interssusception
Meckel's diverticulum
26
Q

dDx change in stools

A 
Inappropriate diet
Celiac disease
Cystic fibrosis
Cow's milk protein intolerance
Toddlers diarrhoea
IBD
Constipation
Parasitic infection
27
Q

Features abdominal migraine

A

Idiopathic disorder with recurrent episodes midline abdominal pain
Associated with GI features
Similar triggers to normal migraines
Advice and analgesia
Management with rescue and prophylactic medications
Likely to later develop migraines

28
Q

Features IBS

A

Frequent episodic relapses
May be precipitated by infection
Excessively forceful contraction and low tolerance of stretch
Often family history
Periumbilical abdominal pain worse before and relieved by defecation
Explosive loose stool with mucus, often alternating with constipation
Abdominal bloating and feeling of incomplete defecation
Symptomatic control by dietary changes and antispasmodics

29
Q

Features peptic ulceration

A

Uncommon in children
Associated with H.Pylori
Testing by endoscopy and blood/stool sample
Classically epigastric pain, waking at night, radiation to the back, occurring after eating or emptying stomach

30
Q

Mx peptic ulceration

A

H. Pylori eradication therapy: metronidazole, clarithromycin and amoxicillin
Acute presentation is perforation: endoscopy for coagulation therapy and haemostatic clips

31
Q

Features gastritis

A

Inflammation of the stomach lining due to food intolerance, medication or infection
Risk factors include stress, poor diet, illness, NSAIDs, caffeine
Nausea, vomiting, upper abdo pain, loss of appetite, abdo distention, flatulence
Mild cases require no treatment

32
Q

Features eosinophillic oesophagitis

A

Eosinophilic inflammatory infiltrate secondary to food or aeo-allergens
Features of esophageal dysfunction
Males with atopic history
Feeding difficulty or refusal, vomiting and regurgitation, retrosternal and epigastric pain, dysphagia, food impaction

33
Q

Mx eosinophilic oesophagitis

A

Endoscopic biopsy, peripheral IgE raised
Subset of patients responsive to PPI
Dietary restriction and exclusion diet in young children
Oral corticosteroids .e.g. Fluticasone

34
Q

Features Colic

A

Unknown mechanism
Discrete episodes of crying and drawing up legs/arching back in young infants
Typically excessive flatus
Sel resolves by 6-12 months

35
Q

Features mesenteric adenitis

A

Common in children under 15 years
Mesenteric lymph node inflammation following viral infection
Acute abdominal pain and associated GI symptoms, with pharyngitis and cervical lymphadenopathy- clinical diagnosis
Alagaesia and hydration
Self limiting

36
Q

Features acute appendicitis

A

Acute inflammation of the appendix due to obstruction of the lumen
Uncommon in children <3 months
Associated with serous free fluid in abdomen visible on US
Periumbilical colicky pain shifting to the RIL becoming constant and severe
Aggravated by movement
Tenderness and guarding with rebound tenderness on palpation
Frequently nausea, vomiting and occasionally anorexia
High grade fever suggests perforation

37
Q

US appendicitis

A

US is low sensitivity but shows thiked non compressible appendix with increased blood flow

38
Q

Mx Appendicitis

A

Appendicectomy

In perforation full wash out followed by 5-10 days of antibiotics

39
Q

Features Meckels Diverticulum

A

Typically causes painless bleeding PR
Ileal remnant of vitelline duct 40-60cm proximal to the ileocaecal valve
Technetium scan demonstrated increased uptake
Surgical resection with adjacent ileal segment

40
Q

Features celiac disease

A

Autoimmune inflammatory response to gliadin fraction of gluten
Age of presentation dependant on gluten introduction: classically 6 months-3 years
Presents with profound malabsorption: fatigue, weight loss, chronic diarrhoea, flatulence, pale stools, buttocks wasting
Associated with other autoimmune conditions

41
Q

Ix celiac disease

A

Diagnosis by positive serology and mucosal change on endoscopy
Iron/folate deficiency anaemia, vitamin B12 deficiency, elevated transaminase following gluten in diet

42
Q

Mx celiac disease

A

Gluten free diet: reintroduction may be trialled in later childhood
Follow up to ensure adherence to diet

43
Q

GI manifestations of cystic fibrosis

A

Increased viscosity of secretion affecting lung and pancreas
Bulky stools resulting in rectal prolapse
Steatorrhoea due to aberrant pancreatic function and poor fat absorption
Malabsorptive conditions cause failure to thrive

44
Q

Features cow’s milk protein intolerance

A

Onset typically when changing to formula feed
Child becomes irritable, vomiting, swelling/rash around mouth
Switch to different formula
Common childhood food allergy
Trial of milk in older childhood usually successful

45
Q

Features toddlers diarrhoea

A

Otherwise well child
Due to increased gastric motility in younger children
Classically diarrhoea with whole pieces of vegetables
Restrict fruit juices nand increase dietary fibre
Usually self resolves

46
Q

Features chrons disease

A

Typically affects distal ileum and proximal colon
Areas of acutely inflamed and thickened bowel with development of strictures and fistulas
Abdo pain, diarrhoea, weight loss, pubertal delay, fever, lethargy

47
Q

Ix Chrons disease

A

Raised platelet, ESR, CRP, iron deficiency anaemia, low serum albumin
Biopsy required for diagnosis

48
Q

Mx Chron’s disease

A

Remission may be induced by dietary change: polymeric diet for 6-8 weeks
Systemic steroids
Immunosuppression required to maintain remission

49
Q

Features ulcerative colitis

A

Recurrent inflammatory ulceration of colon mucosa
Rectal bleeding, diarrhea, colicky pain, weight loss, growth failure
Diagnosis by endoscopy

50
Q

Mx Ulcerative colitis

A

Aminosalicylates .e.g. Mesalazine for induction of remission and maintenance
Disease confided torectum and sigmoid colon may be controlled by steroids

51
Q

Features constipation

A

Common problem in childhood
Dietary changes will typically not have any impact
Possibly a faecal mass palpable on examination

52
Q

Red flags constipation

A

failure to pass meconium within 24 hours, faltering growth, gross abdominal distention, lower limb deformity, sacral dimple, abnormal anus, bruising/fissures, fistulae, abscess

53
Q

Mx constipation

A

Self resolves in some children
Long standing constipation can result in soiling and loss of sensation
Disimpaction regimen with movicol paediatric plan in escalating doses, with addition of stimulant .e.g. Senna
Maintenance therapy by polyethylene glycol
Good toileting behaviour important

54
Q

Features intussusception

A 
invagination of one portion of the bowel into the lumen of adjacent bowel
Usually ileo-caecal region
6-18m
boys>girls
paroxysmal abdominal colic pain
draws up knees
pallor
vomiting
red currant jelly stool (late sign)
Sausage shaped mass in RUQ
55
Q

Ix intussusception

A

target like mass on US

56
Q

Mx intussusception

A

air insufflation under radiological control

Failure of insufflation or peritonitis- surgery

Paediatrics (22 decks)

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